HIV Day 2017

Sub-Saharan Africa is the region worst-affected by HIV and AIDS. HIV/AIDS in South Africa is a prominent health concern; South Africa has the highest prevalence of HIV/AIDS compared to any other country in the world with 5,6 million people living with HIV, and 270,000 HIV related deaths recorded in 2011. (UNAIDS)

The HIV prevalence for South Africa is the percentage of people that are HIV positive in the population out of the total population at a given point in time. One of the main HIV statistics for South Africa is that by the middle of 2017, 12.6% of the population, that is 7.06 million people are HIV positive.1Statistics South Africa Mid-year population estimates 2017 www.statssa.gov.za

There are 1.86 million more People Living with HIV (PLHIV) than in 2008, when the percentage was 10.6, that is 5.2 million people. The increased prevalence of HIV in 2017 is largely due to the combined effect of new infections, and a successfully expanded ARV treatment programme, which has increased survival among people living with HIV.

Looking at the total population, the prevalence in women aged 15-49 is 21.17%, the prevalence in adults aged 15-49 is 17.98% and the prevalence among youth aged 15-24 is 4.64%.2Statistics South Africa Mid-year population estimates 2017 www.statssa.gov.za

Overall women had a significant higher HIV prevalence than men. The prevalence of HIV was highest among women aged 30-34 and among men aged 35-39. In the teenage population the estimated HIV prevalence among women was eight times that of their male equivalents. This suggests that female teenagers aged 15-19 are more likely than their male equivalents to have sex, not with people in the same age group, but with older sex partners. In the age group 30-35 over one third of all women were estimated to be HIV positive.

Why is the South African HIV/AIDS prevalence so high?

Many factors contribute to the spread of HIV. These include: poverty; inequality and social instability; high levels of sexually transmitted infections; the low status of women; sexual violence; high mobility (particularly migrant labour); limited and uneven access to quality medical care; and a history of poor leadership in the response to the epidemic.

Research shows high levels of knowledge about the means of transmission of HIV and understanding of methods of prevention. However, this does not translate into HIV-preventive behaviour. Behaviour change and social change are long-term processes, and the factors that predispose people to infection – such as poverty and inequality, patriarchy and illiteracy – cannot be addressed in the short term. Vulnerability to, and the impact of, the epidemic is proving to be most catastrophic at community and household level.

How has this affected the everyday lives of South Africans?

The hardship for those infected and their families begins long before people die. Stigma and denial related to suspected infection cause many people to delay or refuse testing; fear and despair often follow diagnosis, due to poor-quality counselling and lack of support; poverty prevents many infected people from maintaining adequate nutrition to help prevent the onset of illness; limited access to clinics, waiting lists for ARV treatment programmes and eligibility criteria for access to ARVs mean that many people become seriously ill before accessing treatment; loss of income and support when a breadwinner or caregiver becomes ill, and the diversion of household resources to provide care exacerbate poverty; the burden upon family members, particularly children and older people caring for terminally ill adults, and the trauma of bereavement and orphan hood compromise the physical and mental well-being of entire households. This all happens in a society where the majority of children live in poverty and more than 25% of the economically active population is unemployed.

Women face a greater risk of HIV infection. On average in South Africa there are three women infected with HIV for every two men who are infected. The difference is greatest in the 15-24 age group, where three young women for every one young man are infected.

However, South Africa has made positive strides in managing the HIV and AIDS epidemic since the end of 2008. The numbers of people on antiretroviral treatment has increased dramatically to 1 900 000 and there were 100 000 fewer Aids-related deaths in 2011 than in 2005.

What are the proposed solutions?

For many years, the burden of care and support has fallen heavily on the shoulders of impoverished rural communities, where sick family members return when they can no longer work or care for themselves. Community-based care has been promoted as the best option since it would be impossible to care properly for hundreds of thousands of people dying from AIDS in public hospitals. The resilience and capacity to care for dying people and provide for those they leave behind in impoverished communities is extremely overstretched. There remains an acute need for social protection and interventions to support the most vulnerable communities and households affected by this epidemic. The challenge we still face is that people are not testing timeously therefore only once they are very ill at quite a late stage of disease progression do they only realise that they are HIV positive. The central focus remains that we continue to mobilise an increased uptake in HIV testing and counseling, behaviour change communication and combination prevention and treatment.

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